This application for a Mentored Patient-Oriented Research Career Development Award (K23) is an initial submission by a new investigator. The goal of this award is to provide me with further training in the field of obesity. As part of this training, I have proposed mentoring in the following areas: 1) behavioral treatment of obesity; 2) cognitive behavioral treatment of body image dissatisfaction in obese persons; 3) body composition analysis; and 4) nutrition. In addition, I would like to receive additional training in the conduct of clinical trials. The proposal builds upon my research in body image dissatisfaction of plastic surgery patients and bridges it with my developing interest in the treatment of obesity. Over the past decade, obesity has become a significant public health problem. Almost one-fourth of Americans are now obese, as judged by a body mass index (BMI) of 30 kg/m2 or greater. Weight losses of as little as 5%-10% of initial weight, which are the typical result of behavior modification programs, are thought to improve the health complications of obesity. The great majority of obese persons, however, regain at least one-third of their weight loss in the year following treatment. Thus, improving the maintenance of weight loss remains one of the greatest challenges in the field of obesity. One area of study that maybe related to successful long-term weight maintenance is body image. Obese persons frequently report that dissatisfaction with their appearance and body image is a primary motivation for weight loss. Furthermore, body image dissatisfaction increases during weight regain. Cognitive-behavioral therapy for body image following weight loss may enhance obese persons' body image and prevent weight regain by changing beliefs about successful long-term weight control. The research has two specific aims. The first is to compare long-term changes in weight and body image over 92 weeks in obese women with a BMI <40kg/m2 who receive traditional behavioral weight loss treatment versus traditional weight loss treatment coupled with cognitive-behavioral therapy for body image dissatisfaction during the maintenance phase of treatment. The second aim is to assess body image and psychosocial status of severely obese persons (i.e., BMI>40kg/m2) before and after bariatric surgery. Preoperative psychosocial status of these patients will be compared to that of patients in the body image trial to determine if psychosocial status, including body image, worsens with increasing weight. Pre- and postoperative psychosocial status in the bariatric surgery patients also will be compared to see if surgically induced weight loss is associated with improvements in psychosocial health. These studies have been selected to further develop my knowledge of the treatment of obesity, and the training program has been designed to facilitate my development as an independent investigator in the field of obesity.